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91_HB0182ham001
LRB9100213WHmgam02
1 AMENDMENT TO HOUSE BILL 182
2 AMENDMENT NO. . Amend House Bill 182 by replacing
3 the title with the following:
4 "AN ACT to amend certain Acts in relation to mental
5 health."; and
6 by replacing everything after the enacting clause with the
7 following:
8 "Section 5. The Illinois Act on the Aging is amended by
9 changing Section 4.04 as follows:
10 (20 ILCS 105/4.04) (from Ch. 23, par. 6104.04)
11 Sec. 4.04. Long Term Care Ombudsman Program.
12 (a) Long Term Care Ombudsman Program. The Department
13 shall establish a Long Term Care Ombudsman Program, through
14 the Office of State Long Term Care Ombudsman ("the Office"),
15 in accordance with the provisions of the Older Americans Act
16 of 1965, as now or hereafter amended.
17 (b) Definitions. As used in this Section, unless the
18 context requires otherwise:
19 (1) "Access" has the same meaning as in Section
20 1-104 of the Nursing Home Care Act, as now or hereafter
21 amended; that is, it means the right to:
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1 (i) Enter any long term care facility;
2 (ii) Communicate privately and without
3 restriction with any resident who consents to the
4 communication;
5 (iii) Seek consent to communicate privately
6 and without restriction with any resident;
7 (iv) Inspect the clinical and other records of
8 a resident with the express written consent of the
9 resident;
10 (v) Observe all areas of the long term care
11 facility except the living area of any resident who
12 protests the observation.
13 (2) "Long Term Care Facility" means any facility as
14 defined by Section 1-113 of the Nursing Home Care Act, as
15 now or hereafter amended.
16 (3) "Ombudsman" means any person employed by the
17 Department to fulfill the requirements of the Office, or
18 any representative of a sub-State long term care
19 ombudsman program; provided that the representative,
20 whether he is paid for or volunteers his ombudsman
21 services, shall be qualified and authorized by the
22 Department to perform the duties of an ombudsman as
23 specified by the Department in rules.
24 (c) Ombudsman; rules. The Office of State Long Term Care
25 Ombudsman shall be composed of at least one full-time
26 ombudsman within the Department and shall include a system of
27 designated sub-State long term care ombudsman programs. Each
28 sub-State program shall be designated by the Department as a
29 subdivision of the Office and any representative of a
30 sub-State program shall be treated as a representative of the
31 Office.
32 The Department shall promulgate administrative rules to
33 establish the responsibilities of the Department and the
34 Office of State Long Term Care Ombudsman. The administrative
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1 rules shall include the responsibility of the Office to
2 investigate and resolve complaints made by or on behalf of
3 residents of long term care facilities relating to actions,
4 inaction, or decisions of providers, or their
5 representatives, of long term care facilities, of public
6 agencies, or of social services agencies, which may adversely
7 affect the health, safety, welfare, or rights of such
8 residents. When necessary and appropriate, representatives of
9 the Office shall refer complaints to the appropriate
10 regulatory State agency. The Department shall cooperate with
11 the Department of Human Services in providing information and
12 training to designated sub-State long term care ombudsman
13 programs about the appropriate assessment and treatment
14 (including information about appropriate supportive services,
15 treatment options, and assessment of rehabilitation
16 potential) of persons with mental illness (other than
17 Alzheimer's disease and related disorders).
18 (d) Access and visitation rights.
19 (1) In accordance with subparagraphs (A) and (E) of
20 paragraph (3) of subsection (c) of Section 1819 and
21 subparagraphs (A) and (E) of paragraph (3) of subsection
22 (c) of Section 1919 of the Social Security Act, as now or
23 hereafter amended (42 U.S.C. 1395i-3 (c)(3)(A) and (E)
24 and 42 U.S.C. 1396r-3 (c)(3)(A) and (E)), and Section
25 307(a)(12) of the Older Americans Act of 1965, as now or
26 hereafter amended, a long term care facility must:
27 (i) permit immediate access to any resident by
28 an ombudsman; and
29 (ii) permit representatives of the Office,
30 with the permission of the resident's legal
31 representative or legal guardian, to examine a
32 resident's clinical and other records, and if a
33 resident is unable to consent to such review, and
34 has no legal guardian, permit representatives of the
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1 Office appropriate access, as defined by the
2 Department in administrative rules, to the
3 resident's records.
4 (2) Each long term care facility shall display, in
5 multiple, conspicuous public places within the facility
6 accessible to both visitors and patients and in an easily
7 readable format, the address and phone number of the
8 Office, in a manner prescribed by the Office.
9 (e) Immunity. An ombudsman or any other representative
10 of the Office participating in the good faith performance of
11 his or her official duties shall have immunity from any
12 liability (civil, criminal or otherwise) in any proceedings
13 (civil, criminal or otherwise) brought as a consequence of
14 the performance of his official duties.
15 (f) Business offenses.
16 (1) No person shall:
17 (i) Intentionally prevent, interfere with, or
18 attempt to impede in any way any representative of
19 the Office in the performance of his official duties
20 under this Act and the Older Americans Act of 1965;
21 or
22 (ii) Intentionally retaliate, discriminate
23 against, or effect reprisals against any long term
24 care facility resident or employee for contacting or
25 providing information to any representative of the
26 Office.
27 (2) A violation of this Section is a business
28 offense, punishable by a fine not to exceed $501.
29 (3) The Director of Aging shall notify the State's
30 Attorney of the county in which the long term care
31 facility is located, or the Attorney General, of any
32 violations of this Section.
33 (g) Confidentiality of records and identities. No files
34 or records maintained by the Office of State Long Term Care
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1 Ombudsman shall be disclosed unless the State Ombudsman or
2 the ombudsman having the authority over the disposition of
3 such files authorizes the disclosure in writing. The
4 ombudsman shall not disclose the identity of any complainant,
5 resident, witness or employee of a long term care provider
6 involved in a complaint or report unless such person or such
7 person's guardian or legal representative consents in writing
8 to the disclosure, or the disclosure is required by court
9 order.
10 (h) Legal representation. The Attorney General shall
11 provide legal representation to any representative of the
12 Office against whom suit or other legal action is brought in
13 connection with the performance of the representative's
14 official duties, in accordance with "An Act to provide for
15 representation and indemnification in certain civil law
16 suits", approved December 3, 1977, as now or hereafter
17 amended.
18 (i) Treatment by prayer and spiritual means. Nothing in
19 this Act shall be construed to authorize or require the
20 medical supervision, regulation or control of remedial care
21 or treatment of any resident in a long term care facility
22 operated exclusively by and for members or adherents of any
23 church or religious denomination the tenets and practices of
24 which include reliance solely upon spiritual means through
25 prayer for healing.
26 (Source: P.A. 90-639, eff. 1-1-99.)
27 Section 10. The Mental Health and Developmental
28 Disabilities Administrative Act is amended by changing
29 Sections 4, 7, and 15 and adding Sections 15.4 and 71 as
30 follows:
31 (20 ILCS 1705/4) (from Ch. 91 1/2, par. 100-4)
32 Sec. 4. Supervision of facilities and services;
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1 quarterly reports.
2 (a) To exercise executive and administrative supervision
3 over all facilities, divisions, programs and services now
4 existing or hereafter acquired or created under the
5 jurisdiction of the Department, including, but not limited
6 to, the following:
7 The Alton Mental Health Center, at Alton
8 The Clyde L. Choate Mental Health and Developmental
9 Center, at Anna
10 The Chester Mental Health Center, at Chester
11 The Chicago-Read Mental Health Center, at Chicago
12 The Elgin Mental Health Center, at Elgin
13 The Metropolitan Children and Adolescents Center, at
14 Chicago
15 The Jacksonville Developmental Center, at
16 Jacksonville
17 The Governor Samuel H. Shapiro Developmental Center,
18 at Kankakee
19 The Tinley Park Mental Health Center, at Tinley Park
20 The Warren G. Murray Developmental Center, at
21 Centralia
22 The Jack Mabley Developmental Center, at Dixon
23 The Lincoln Developmental Center, at Lincoln
24 The H. Douglas Singer Mental Health and
25 Developmental Center, at Rockford
26 The John J. Madden Mental Health Center, at Chicago
27 The George A. Zeller Mental Health Center, at Peoria
28 The Andrew McFarland Mental Health Center, at
29 Springfield
30 The Adolf Meyer Mental Health Center, at Decatur
31 The William W. Fox Developmental Center, at Dwight
32 The Elisabeth Ludeman Developmental Center, at Park
33 Forest
34 The William A. Howe Developmental Center, at Tinley
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1 Park
2 The Ann M. Kiley Developmental Center, at Waukegan.
3 (b) Beginning not later than July 1, 1977, the
4 Department shall cause each of the facilities under its
5 jurisdiction which provide in-patient care to comply with
6 standards, rules and regulations of the Department of Public
7 Health prescribed under Section 6.05 of the "Hospital
8 Licensing Act", approved July 1, 1953, as amended.
9 (c) The Department shall issue quarterly reports on
10 admissions, deflections, discharges, bed closures,
11 staff-resident ratios, census, average length of stay, and
12 any adverse federal certification or accreditation findings,
13 if any, for each State-operated facility for the mentally ill
14 and developmentally disabled.
15 (Source: P.A. 87-447; 89-439, eff. 6-1-96; revised 10-31-98.)
16 (20 ILCS 1705/7) (from Ch. 91 1/2, par. 100-7)
17 Sec. 7. To receive and provide the highest possible
18 quality of humane and rehabilitative care and treatment to
19 all persons admitted or committed or transferred in
20 accordance with law to the facilities, divisions, programs,
21 and services under the jurisdiction of the Department. No
22 resident of another state shall be received or retained to
23 the exclusion of any resident of this State. No resident of
24 another state shall be received or retained to the exclusion
25 of any resident of this State. All recipients of 17 years of
26 age and under in residence in a Department facility other
27 than a facility for the care of the mentally retarded shall
28 be housed in quarters separated from older recipients except
29 for: (a) recipients who are placed in medical-surgical units
30 because of physical illness; and (b) recipients between 13
31 and 18 years of age who need temporary security measures.
32 All recipients in a Department facility shall be given a
33 dental examination by a licensed dentist or registered dental
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1 hygienist at least once every 18 months and shall be assigned
2 to a dentist for such dental care and treatment as is
3 necessary.
4 All medications administered to recipients shall be
5 administered only by those persons who are legally qualified
6 to do so by the laws of the State of Illinois. Medication
7 shall not be prescribed until a physical and mental
8 examination of the recipient has been completed. If, in the
9 clinical judgment of a physician, it is necessary to
10 administer medication to a recipient before the completion of
11 the physical and mental examination, he may prescribe such
12 medication but he must file a report with the facility
13 director setting forth the reasons for prescribing such
14 medication within 24 hours of the prescription. A copy of the
15 report shall be part of the recipient's record.
16 No later than January 1, 2000, the Department shall adopt
17 standards for recording on a prescribed form all patient
18 diagnosis, care, and treatment at every facility under the
19 jurisdiction of the Department.
20 Every facility under the jurisdiction of the Department
21 shall maintain a copy of each report of suspected abuse or
22 neglect of the patient. Copies of those reports shall be made
23 available to the State Auditor General in connection with his
24 biennial program audit of the facility as required by Section
25 3-2 of the Illinois State Auditing Act.
26 No later than January 1, 2000, every facility under the
27 jurisdiction of the Department and all services provided in
28 those facilities shall comply with all of the applicable
29 standards adopted by the Social Security Administration under
30 Subchapter XVIII (Medicare) of the Social Security Act (42
31 U.S.C. 1395 - 1395ccc).
32 (Source: P.A. 86-922; 86-1013; 86-1475.)
33 (20 ILCS 1705/15) (from Ch. 91 1/2, par. 100-15)
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1 Sec. 15. Before any person is released from a facility
2 operated by the State pursuant to an absolute discharge or a
3 conditional discharge from hospitalization under this Act,
4 the facility director of the facility in which such person is
5 hospitalized shall determine that such person is not
6 currently in need of hospitalization and:
7 (a) is able to live independently in the community;
8 or
9 (b) requires further oversight and supervisory care
10 for which arrangements have been made with responsible
11 relatives or supervised residential program approved by
12 the Department; or
13 (c) requires further personal care or general
14 oversight as defined by the Nursing Home Care Act, for
15 which placement arrangements have been made with a
16 suitable family home or other licensed facility approved
17 by the Department under this Section; or
18 (d) requires community mental health services for
19 which arrangements have been made with a suitable
20 community mental health provider.
21 Such determination shall be made in writing and shall
22 become a part of the facility record of such absolutely or
23 conditionally discharged person. When the determination
24 indicates that the condition of the person to be granted an
25 absolute discharge or a conditional discharge is described
26 under subparagraph (c) or (d) of this Section, the name and
27 address of the continuing care facility or home to which such
28 person is to be released shall be entered in the facility
29 record. Where a discharge from a mental health facility is
30 made under subparagraph (c), the Department shall assign the
31 person so discharged to an existing community based
32 not-for-profit agency for participation in day activities
33 suitable to the person's needs, such as but not limited to
34 social and vocational rehabilitation, and other recreational,
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1 educational and financial activities unless the community
2 based not-for-profit agency is unqualified to accept such
3 assignment. Where the clientele of any not-for-profit agency
4 increases as a result of assignments under this amendatory
5 Act of 1977 by more than 3% over the prior year, the
6 Department shall fully reimburse such agency for the costs of
7 providing services to such persons in excess of such 3%
8 increase. The Department shall keep written records detailing
9 how many persons have been assigned to a community based
10 not-for-profit agency and how many persons were not so
11 assigned because the community based agency was unqualified
12 to accept the assignments. Whenever a community based agency
13 is found to be unqualified, the name of the agency and the
14 reason for the finding shall be included in the report. The
15 report shall be available to the public under the Freedom of
16 Information Act.
17 Insofar as desirable in the interests of the former
18 recipient, the facility, program or home in which the
19 discharged person is to be placed shall be located in or near
20 the community in which the person resided prior to
21 hospitalization or in the community in which the person's
22 family or nearest next of kin presently reside. Placement of
23 the discharged person in facilities, programs or homes
24 located outside of this State shall not be made by the
25 Department unless there are no appropriate facilities,
26 programs or homes available within this State. Out-of-state
27 placements shall be subject to return of recipients so placed
28 upon the availability of facilities, programs or homes within
29 this State to accommodate these recipients, except where
30 placement in a contiguous state results in locating a
31 recipient in a facility or program closer to the recipient's
32 home or family. If an appropriate facility or program
33 becomes available equal to or closer to the recipient's home
34 or family, the recipient shall be returned to and placed at
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1 the appropriate facility or program within this State.
2 To place any person who is under a program of the
3 Department at board in a suitable family home or in such
4 other facility or program as the Department may consider
5 desirable. The Department may place in licensed nursing
6 homes, sheltered care homes, or homes for the aged those
7 persons whose behavioral manifestations and medical and
8 nursing care needs are such as to be substantially
9 indistinguishable from persons already living in such
10 facilities. Prior to any placement by the Department under
11 this Section, a determination shall be made by the personnel
12 of the Department, as to the capability and suitability of
13 such facility to adequately meet the needs of the person to
14 be discharged. When specialized programs are necessary in
15 order to enable persons in need of supervised living to
16 develop and improve in the community, the Department shall
17 place such persons only in specialized residential care
18 facilities which shall meet Department standards including
19 restricted admission policy, special staffing and programming
20 for social and vocational rehabilitation, in addition to the
21 requirements of the appropriate State licensing agency. The
22 Department shall not place any new person in a facility the
23 license of which has been revoked or not renewed on grounds
24 of inadequate programming, staffing, or medical or adjunctive
25 services, regardless of the pendency of an action for
26 administrative review regarding such revocation or failure to
27 renew. Before the Department may transfer any person to a
28 licensed nursing home, sheltered care home or home for the
29 aged or place any person in a specialized residential care
30 facility the Department shall notify the person to be
31 transferred, or a responsible relative of such person, in
32 writing, at least 30 days before the proposed transfer, with
33 respect to all the relevant facts concerning such transfer,
34 except in cases of emergency when such notice is not
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1 required. If either the person to be transferred or a
2 responsible relative of such person objects to such transfer,
3 in writing to the Department, at any time after receipt of
4 notice and before the transfer, the facility director of the
5 facility in which the person was a recipient shall
6 immediately schedule a hearing at the facility with the
7 presence of the facility director, the person who objected to
8 such proposed transfer, and a psychiatrist who is familiar
9 with the record of the person to be transferred. Such person
10 to be transferred or a responsible relative may be
11 represented by such counsel or interested party as he may
12 appoint, who may present such testimony with respect to the
13 proposed transfer. Testimony presented at such hearing shall
14 become a part of the facility record of the
15 person-to-be-transferred. The record of testimony shall be
16 held in the person-to-be-transferred's record in the central
17 files of the facility. If such hearing is held a transfer may
18 only be implemented, if at all, in accordance with the
19 results of such hearing. Within 15 days after such hearing
20 the facility director shall deliver his findings based on the
21 record of the case and the testimony presented at the
22 hearing, by registered or certified mail, to the parties to
23 such hearing. The findings of the facility director shall be
24 deemed a final administrative decision of the Department. For
25 purposes of this Section, "case of emergency" means those
26 instances in which the health of the person to be transferred
27 is imperiled and the most appropriate mental health care or
28 medical care is available at a licensed nursing home,
29 sheltered care home or home for the aged or a specialized
30 residential care facility.
31 Prior to placement of any person in a facility under this
32 Section the Department shall ensure that an appropriate
33 training plan for staff is provided by the facility. Said
34 training may include instruction and demonstration by
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1 Department personnel qualified in the area of mental illness
2 or mental retardation, as applicable to the person to be
3 placed. Training may be given both at the facility from
4 which the recipient is transferred and at the facility
5 receiving the recipient, and may be available on a continuing
6 basis subsequent to placement. In a facility providing
7 services to former Department recipients, training shall be
8 available as necessary for facility staff. Such training
9 will be on a continuing basis as the needs of the facility
10 and recipients change and further training is required.
11 The Department shall not place any person in a facility
12 which does not have appropriately trained staff in sufficient
13 numbers to accommodate the recipient population already at
14 the facility. As a condition of further or future placements
15 of persons, the Department shall require the employment of
16 additional trained staff members at the facility where said
17 persons are to be placed. The Secretary, or his or her
18 designate, shall establish written guidelines for placement
19 of persons in facilities under this Act. The Department shall
20 keep written records detailing which facilities have been
21 determined to have appropriately trained staff, which
22 facilities have been determined not to have such staff, and
23 all training which it has provided or required under this
24 Section. The records shall be available to the public under
25 the Freedom of Information Act.
26 Bills for the support for a person boarded out shall be
27 payable monthly out of the proper maintenance funds and shall
28 be audited as any other accounts of the Department. If a
29 person is placed in a facility or program outside the
30 Department, the Department may pay the actual costs of
31 residence, treatment or maintenance in such facility and may
32 collect such actual costs or a portion thereof from the
33 recipient or the estate of a person placed in accordance with
34 this Section.
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1 Other than those placed in a family home the Department
2 shall cause all persons who are placed in a facility, as
3 defined by the Nursing Home Care Act, or in designated
4 community living situations or programs, to be visited at
5 least once during the first month following placement, and
6 once every month thereafter for the first year following
7 placement when indicated. After the first year, visits shall
8 be made every 6 months. If a long term care facility has
9 periodic care plan conferences, the visitor shall participate
10 in those conferences except that, following the first year of
11 placement, the visitor need only participate once a year.
12 Visits shall be made by qualified and trained Department
13 personnel, or their designee, in the area of mental health or
14 developmental disabilities applicable to the person visited,
15 and shall be made on a more frequent basis when indicated.
16 The Department may not use as designee any personnel
17 connected with or responsible to the representatives of any
18 facility in which persons who have been transferred under
19 this Section are placed. In the course of such visit there
20 shall be consideration of the following areas, but not
21 limited thereto: effects of transfer on physical and mental
22 health of the person, sufficiency of nursing care and medical
23 coverage required by the person, sufficiency of staff
24 personnel and ability to provide basic care for the person,
25 social, recreational and programmatic activities available
26 for the person, and other appropriate aspects of the person's
27 environment.
28 A report containing the above observations shall be made
29 to the Department and to any other appropriate agency
30 subsequent to each visitation. The report shall contain a
31 detailed assessment of whether the recipient is receiving
32 adequate and humane care and services in the least
33 restrictive environment. If the recipient is not receiving
34 those services, the Department shall either require that the
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1 facility modify the treatment plan to ensure that those
2 services are provided or make arrangements necessary to
3 provide those services elsewhere. At the conclusion of one
4 year following absolute or conditional discharge, or a longer
5 period of time if required by the Department, the Department
6 may terminate the visitation requirements of this Section as
7 to a person placed in accordance with this Section, by filing
8 a written statement of termination setting forth reasons to
9 substantiate the termination of visitations in the person's
10 file, and sending a copy thereof to the person, and to his
11 guardian or next of kin.
12 Upon the complaint of any person placed in accordance
13 with this Section or any responsible citizen or upon
14 discovery that such person has been abused, neglected, or
15 improperly cared for, or that the placement does not provide
16 the type of care required by the recipient's current
17 condition, the Department immediately shall investigate, and
18 determine if the well-being, health, care, or safety of any
19 person is affected by any of the above occurrences, and if
20 any one of the above occurrences is verified, the Department
21 shall remove such person at once to a facility of the
22 Department or to another facility outside the Department,
23 provided such person's needs can be met at said facility.
24 The Department may also provide any person placed in
25 accordance with this Section who is without available funds,
26 and who is permitted to engage in employment outside the
27 facility, such sums for the transportation, and other
28 expenses as may be needed by him until he receives his wages
29 for such employment.
30 The Department shall promulgate rules and regulations
31 governing the purchase of care for persons who are wards of
32 or who are receiving services from the Department. Such
33 rules and regulations shall apply to all monies expended by
34 any agency of the State of Illinois for services rendered by
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1 any person, corporate entity, agency, governmental agency or
2 political subdivision whether public or private outside of
3 the Department whether payment is made through a contractual,
4 per-diem or other arrangement. No funds shall be paid to any
5 person, corporation, agency, governmental entity or political
6 subdivision without compliance with such rules and
7 regulations.
8 The rules and regulations governing purchase of care
9 shall describe categories and types of service deemed
10 appropriate for purchase by the Department.
11 Any provider of services under this Act may elect to
12 receive payment for those services, and the Department is
13 authorized to arrange for that payment, by means of direct
14 deposit transmittals to the service provider's account
15 maintained at a bank, savings and loan association, or other
16 financial institution. The financial institution shall be
17 approved by the Department, and the deposits shall be in
18 accordance with rules and regulations adopted by the
19 Department.
20 The Department shall keep written records of the number
21 of persons it places in long term care facilities each year.
22 The records shall include the name and address of each
23 facility and the diagnosis of each individual so placed. The
24 records shall be available to the public under the Freedom of
25 Information Act.
26 (Source: P.A. 89-507, eff. 7-1-97; 90-423, eff. 8-15-97.)
27 (20 ILCS 1705/15.4 new)
28 Sec. 15.4. Quality assurance for recipients in long term
29 care facilities. Beginning on January 1, 2000, the following
30 shall apply to all residents of long term care facilities, as
31 defined by the Nursing Home Care Act, which are also
32 classified as institutions for mental diseases under 42
33 U.S.C. 1396d(i):
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1 (a) The Department shall cause all persons who reside in
2 those facilities to be visited every 6 months. If the
3 facility has periodic care plan conferences, the visitor
4 shall participate in those conferences at least once a year.
5 Visits shall be made by qualified and trained Department
6 personnel, or their designee, in the area of mental health or
7 developmental disabilities applicable to the person visited,
8 and shall be made on a more frequent basis when indicated.
9 The Department may not use as designee any personnel
10 connected with or responsible to the representatives of any
11 facility in which persons who have been transferred under
12 this Section are placed. In the course of the visit there
13 shall be consideration of areas including but not limited to
14 the following: effects of transfer on physical and mental
15 health of the person, sufficiency of nursing care and medical
16 coverage required by the person, sufficiency of staff
17 personnel and ability to provide basic care for the person,
18 social, recreational, and programmatic activities available
19 for the person, and other appropriate aspects of the person's
20 environment. A report containing the above observations
21 shall be made to the Department and to any other appropriate
22 agency after each visitation. The report shall contain a
23 detailed assessment of whether the recipient is receiving
24 adequate and humane care and services in the least
25 restrictive environment. If the recipient is not receiving
26 those services, the Department shall either require that the
27 facility modify the treatment plan to ensure that those
28 services are provided or make arrangements necessary to
29 provide those services elsewhere.
30 (b) Upon the complaint of any person who resides in a
31 facility governed by this Section or any responsible citizen
32 or upon discovery that the person has been abused, neglected,
33 or improperly cared for, or that the placement does not
34 provide the type of care required by the recipient's current
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1 condition, the Department immediately shall investigate and
2 determine whether the well-being, health, care, or safety of
3 any person is affected by any of the above occurrences. If
4 any one of the above occurrences is verified, the Department
5 shall remove the person at once to a facility of the
6 Department or to another facility outside the Department, if
7 the person's needs can be met at said facility. The
8 Department may also provide any person placed in accordance
9 with this Section who is without available funds, and who is
10 permitted to engage in employment outside the facility, such
11 sums for transportation and other expenses as may be needed
12 by him or her until he or she receives his or her wages for
13 that employment.
14 (c) The Department shall ensure that each resident is
15 provided with day activities suitable to the person's needs,
16 such as but not limited to social and vocational
17 rehabilitation and other recreational, educational, and
18 financial activities. If the facility does not provide these
19 activities, the Department shall assign the resident to an
20 existing community based not-for-profit agency. If the
21 clientele of any not-for-profit agency increases as a result
22 of assignments under this amendatory Act of the 91st General
23 Assembly by more than 3% over the prior year, the Department
24 shall fully reimburse the agency for the costs of providing
25 services to those persons in excess of the 3% increase. The
26 Department shall keep written records detailing how many
27 persons have been assigned to a community based
28 not-for-profit agency and how many persons were not so
29 assigned because the community based agency was unqualified
30 to accept the assignments. If a community based agency is
31 found to be unqualified, the name of the agency and the
32 reason for the finding shall be included in the report. The
33 report shall be available to the public under the Freedom of
34 Information Act.
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1 (d) The Department shall ensure that an appropriate
2 training plan for staff is provided by the facility. The
3 training may include instruction and demonstration by
4 Department personnel qualified in the are of mental illness
5 or mental retardation, as applicable to the person to be
6 placed. Training may be given both at the facility from
7 which the recipient is transferred and at the facility
8 receiving the recipient, and may be available on a continuing
9 basis after placement. The training shall be on continuing
10 basis as the needs of the facility and recipients change and
11 further training is required. The Department shall keep
12 written records detailing which facilities have been
13 determined to have appropriately trained staff, which
14 facilities have been determined not to have appropriately
15 trained staff and all training which it has provided or
16 required under this Section. The records shall be available
17 to the public under the Freedom of Information Act.
18 (20 ILCS 1705/71 new)
19 Sec. 71. Resident Assessment.
20 (1) The Department of Human Services shall arrange for
21 the independent expert evaluation of every person with a
22 primary or secondary diagnosis of mental illness (other than
23 Alzheimer's disease or a related disorder) residing in every
24 facility licensed under the Nursing Home Care Act to provide
25 skilled, intermediate, or sheltered care to adults. The
26 evaluation shall describe, at a minimum, each individual's
27 current mental health status, treatment needs, and
28 rehabilitation potential, and the extent to which the current
29 placement is meeting those needs. The evaluation shall
30 include a recommendation about the most appropriate treatment
31 setting for the individual. The assessment of treatment needs
32 and rehabilitation potential shall be made without regard for
33 the current availability of the services an individual may
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1 need.
2 (2) Evaluations shall be performed by qualified mental
3 health professionals. Reimbursement shall be at the same rate
4 as that paid for the pre-admission screenings required by
5 Title 19 of the Social Security Act. The Department of Human
6 Services may use existing pre-admission screening agencies
7 and pre-admission agents to perform the evaluations, except
8 that no evaluation of any resident may be performed by any
9 agent or agency which has previously performed a
10 pre-admission screening evaluation of the resident. The
11 Department of Human Services may use the current
12 pre-admission screening assessment tool as the basis for the
13 evaluation, supplemented as necessary to provide the
14 information necessary to make treatment and placement
15 recommendations.
16 (3) The Department of Human Services shall arrange for
17 an agent independent of any executive department of the State
18 of Illinois to review and monitor the evaluation process
19 mandated by this Section. Upon completion of 25% of the
20 mandated evaluations, the agent shall review not fewer that
21 5% of the evaluations to determine if they have been
22 performed in compliance with the purpose and requirements of
23 this Section. The agent shall issue a written report of its
24 findings forthwith, which shall be made public upon delivery
25 to the Department of Human Services and sent forthwith by the
26 Department of Human Services to the General Assembly. If the
27 agent determines that the evaluations are not being completed
28 in compliance with the purpose and requirements of this
29 Section, it shall make recommendations for necessary changes
30 in the assessment process which shall be adopted by the
31 Department of Human Services in conducting any remaining
32 assessments.
33 (4) The Department of Public Aid may not deny
34 reimbursement for nursing home services for any person, and
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1 no person shall be discharged from any nursing facility,
2 because of the findings of any assessment made under this
3 Section that the person does not need nursing home care
4 unless there are available to that person, in a less
5 restrictive setting, the housing, mental health services,
6 medical services, and other supportive services he or she
7 needs.
8 (5) The Department of Human Services shall also prepare
9 an assessment of each mental health comprehensive community
10 service network in the State. This assessment shall evaluate
11 the resources needed in each network to provide appropriate
12 mental health services for all people within the network's
13 service area who have mental illness. As used in this
14 subsection (5), "mental illness" means a mental or emotional
15 disorder verified by a diagnosis contained in the Diagnostic
16 and Statistical Manual of Mental Disorders, Third
17 Edition-Revised (or any subsequent edition) or International
18 Classification of Diseases, Ninth Revision, Clinical
19 Modification (or any subsequent revision) which substantially
20 impairs the individual's cognitive, emotional, or behavioral
21 functioning; excluding V codes, organic disorders such as
22 dementia and those associated with known or unknown physical
23 conditions such as hallucinosis, amnestic disorder, and
24 delirium; psychoactive substance induced organic disorders;
25 and mental retardation or psychoactive substance use
26 disorder. For purposes of this subsection (5), "mental
27 illness" does not exclude a dual diagnosis of mental illness
28 and mental retardation or mental illness and psychoactive
29 substance use disorders. The assessments shall include, at
30 a minimum, an analysis of the current availability and needs
31 in each of the following areas: (i) mental health treatment,
32 (ii) qualified mental health professionals, (iii) case
33 managers, (iv) programs for psychosocial rehabilitation, (v)
34 housing and supportive services, (vi) vocational assistance,
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1 and (vii) programs for substance abuse.
2 (6) The Department of Human Services shall maintain the
3 bed capacity of each state-operated facility as of January 1,
4 1999 until completion of the assessments required by
5 subsection (1) of this Section.
6 (7) By June 30, 2000, the Department of Human Services
7 shall complete all required individual and network
8 assessments and shall submit a written report to the Governor
9 and General Assembly which describes the results of the
10 assessment process and contains a specific plan to address
11 the needs for mental health services which that process has
12 identified.
13 Section 15. The Nursing Home Care Act is amended by
14 changing Sections 2-104, 2-106, 2-106.1, 3-202, and 3-212 and
15 by adding Section 2-101.2 as follows:
16 (210 ILCS 45/2-101.2 new)
17 Sec. 2-101.2. Application of Mental Health and
18 Developmental Disabilities Act. The Mental Health and
19 Developmental Disabilities Act and the Mental Health and
20 Developmental Disabilities Confidentiality Act apply to all
21 persons residing in an institution for mental diseases, as
22 defined in 24 U.S.C. 1396d(i). To the extent that there is
23 any conflict between the Mental Health and Developmental
24 Disabilities Act, the Mental Health and Developmental
25 Disability Confidentiality Act, and this Act or any federal
26 law or regulation, the provision which is more protective of
27 the rights of residents shall govern.
28 (210 ILCS 45/2-104) (from Ch. 111 1/2, par. 4152-104)
29 Sec. 2-104. (a) A resident shall be permitted to retain
30 the services of his own personal physician at his own expense
31 or under an individual or group plan of health insurance, or
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1 under any public or private assistance program providing such
2 coverage. However, the facility is not liable for the
3 negligence of any such personal physician. Every resident
4 shall be permitted to obtain from his own physician or the
5 physician attached to the facility complete and current
6 information concerning his medical diagnosis, treatment and
7 prognosis in terms and language the resident can reasonably
8 be expected to understand. Every resident shall be permitted
9 to participate in the planning of his total care and medical
10 treatment to the extent that his condition permits. No
11 resident shall be subjected to experimental research or
12 treatment without first obtaining his informed, written
13 consent. The conduct of any experimental research or
14 treatment shall be authorized and monitored by an
15 institutional review committee appointed by the administrator
16 of the facility where such research and treatment is
17 conducted. The membership, operating procedures and review
18 criteria for institutional review committees shall be
19 prescribed under rules and regulations of the Department.
20 (b) All medical treatment and procedures shall be
21 administered as ordered by a physician. All new physician
22 orders shall be reviewed by the facility's director of
23 nursing or charge nurse designee within 24 hours after such
24 orders have been issued to assure facility compliance with
25 such orders.
26 According to rules adopted by the Department, every woman
27 resident of child-bearing age shall receive routine
28 obstetrical and gynecological evaluations as well as
29 necessary prenatal care.
30 Every resident with a diagnosis of mental illness (other
31 than Alzheimer's disease or a related disorder) shall receive
32 necessary mental health services, including but not limited
33 to medical management, individual and group therapy,
34 psychosocial rehabilitation, vocational services, and partial
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1 hospitalization. Services shall be appropriate to meet the
2 needs of the individual resident, and may be provided by the
3 facility or by an outside mental health services provider, in
4 the facility or in an appropriate setting elsewhere. A
5 facility shall assist in arranging for a resident to receive
6 services from an outside provider when the services meet the
7 resident's needs and the resident wishes to receive them.
8 (c) Every resident shall be permitted to refuse medical
9 treatment and to know the consequences of such action, unless
10 such refusal would be harmful to the health and safety of
11 others and such harm is documented by a physician in the
12 resident's clinical record. The resident's refusal shall
13 free the facility from the obligation to provide the
14 treatment.
15 (d) Every resident, resident's guardian, or parent if
16 the resident is a minor shall be permitted to inspect and
17 copy all his clinical and other records concerning his care
18 and maintenance kept by the facility or by his physician. The
19 facility may charge a reasonable fee for duplication of a
20 record.
21 (Source: P.A. 86-1013.)
22 (210 ILCS 45/2-106) (from Ch. 111 1/2, par. 4152-106)
23 Sec. 2-106. (a) For purposes of this Act, (i) a physical
24 restraint is any manual method or physical or mechanical
25 device, material, or equipment attached or adjacent to a
26 resident's body that the resident cannot remove easily and
27 restricts freedom of movement or normal access to one's body;
28 (ii) a chemical restraint is any drug used for discipline or
29 convenience and not required to treat medical symptoms. The
30 Department shall by rule, designate certain devices as
31 restraints, including at least all those devices which have
32 been determined to be restraints by the United States
33 Department of Health and Human Services in interpretive
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1 guidelines issued for the purposes of administering Titles 18
2 and 19 of the Social Security Acts.
3 (b) Neither restraints nor confinements shall be
4 employed for the purpose of punishment or for the convenience
5 of any facility personnel. No restraints or confinements
6 shall be employed except as ordered by a physician who
7 documents the need for such restraints or confinements in the
8 resident's clinical record. Whenever a resident of an
9 institution for mental diseases is restrained, a member of
10 the facility staff shall remain with the resident at all
11 times unless the recipient has been confined. A resident who
12 is restrained and confined shall be observed by a qualified
13 person as often as is clinically appropriate but in no event
14 less often than once every 15 minutes.
15 (c) A restraint may be used only with the informed
16 consent of the resident, the resident's guardian, or other
17 authorized representative. A restraint may be used only for
18 specific periods, if it is the least restrictive means
19 necessary to attain and maintain the resident's highest
20 practicable physical, mental or psychosocial well-being,
21 including brief periods of time to provide necessary
22 life-saving treatment. A restraint may be used only after
23 consultation with appropriate health professionals, such as
24 occupational or physical therapists, and a trial of less
25 restrictive measures has led to the determination that the
26 use of less restrictive measures would not attain or maintain
27 the resident's highest practicable physical, mental or
28 psychosocial well-being. However, if the resident needs
29 emergency care, restraints may be used for brief periods to
30 permit medical treatment to proceed unless the facility has
31 notice that the resident has previously made a valid refusal
32 of the treatment in question.
33 (d) A restraint may be applied only by a person trained
34 in the application of the particular type of restraint.
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1 (e) Whenever a period of use of a restraint is
2 initiated, the resident shall be advised of his or her right
3 to have a person or organization of his or her choosing,
4 including the Guardianship and Advocacy Commission, notified
5 of the use of the restraint. A recipient who is under
6 guardianship may request that a person or organization of his
7 or her choosing be notified of the restraint, whether or not
8 the guardian approves the notice. If the resident so
9 chooses, the facility shall make the notification within 24
10 hours, including any information about the period of time
11 that the restraint is to be used. Whenever the Guardianship
12 and Advocacy Commission is notified that a resident has been
13 restrained, it shall contact the resident to determine the
14 circumstances of the restraint and whether further action is
15 warranted.
16 (f) Whenever a restraint is used on a resident whose
17 primary mode of communication is sign language, the resident
18 shall be permitted to have his or her hands free from
19 restraint for brief periods each hour, except when this
20 freedom may result in physical harm to the resident or
21 others.
22 (g) The requirements of this Section are intended to
23 control in any conflict with the requirements of Sections
24 1-126 and 2-108 of the Mental Health and Developmental
25 Disabilities Code.
26 (Source: P.A. 88-413.)
27 (210 ILCS 45/2-106.1)
28 Sec. 2-106.1. Drug treatment.
29 (a) A resident shall not be given unnecessary drugs. An
30 unnecessary drug is any drug used in an excessive dose,
31 including in duplicative therapy; for excessive duration;
32 without adequate monitoring; without adequate indications for
33 its use; or in the presence of adverse consequences that
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1 indicate the drugs should be reduced or discontinued. The
2 Department shall adopt, by rule, the standards for
3 unnecessary drugs contained in interpretive guidelines issued
4 by the United States Department of Health and Human Services
5 for the purposes of administering titles 18 and 19 of the
6 Social Security Act.
7 (b) Psychotropic medication shall not be prescribed
8 without the informed consent of the resident, the resident's
9 guardian, or other authorized representative. "Psychotropic
10 medication" means medication that is used for or listed as
11 used for antipsychotic, antidepressant, antimanic, or
12 antianxiety behavior modification or behavior management
13 purposes in the latest editions of the AMA Drug Evaluations
14 or the Physician's Desk Reference.
15 (c) To the extent that there is any conflict between the
16 requirements of this Section and are intended to control in a
17 conflict with the requirements of Sections 1-102 and 2-107.2
18 of the Mental Health and Developmental Disabilities Code with
19 respect to the administration of psychotropic medication, the
20 provision which is more protective of the rights of residents
21 shall govern.
22 (Source: P.A. 88-413.)
23 (210 ILCS 45/3-203) (from Ch. 111 1/2, par. 4153-203)
24 Sec. 3-203. In licensing any facility for persons with a
25 developmental disability or persons suffering from mental
26 illness (other than Alzheimer's disease or related disorders)
27 emotional or behavioral disorders, the Department shall
28 consult with the Department of Human Services in developing
29 minimum standards for such persons. The Department, in
30 consultation with the Department of Human Services, shall
31 contract with an independent agent to evaluate the nursing
32 home resident assessment instrument mandated for State use by
33 the Health Care Financing Administration in nursing homes
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1 certified for participation in Titles 18 and 19 of the Social
2 Security Act, and the resident assessment protocols mandated
3 for use with the assessment instrument. To provide
4 information about the current mental health-related needs and
5 rehabilitation potential of a resident with a diagnosis of
6 mental illness (other than Alzheimer's disease or related
7 disorders) necessary to do appropriate care planning for each
8 such resident, the evaluation shall include recommendations
9 about: (1) what questions should be added to the assessment
10 tool; and (2) what additions should be made to the assessment
11 protocols. The evaluation shall be made public upon
12 delivery to the Department.
13 The evaluation shall form the basis for rule-making by
14 the Department requiring use of the revised instrument and
15 protocols in assessing the needs and planning the care of all
16 persons with a diagnosis of mental illness (other than
17 Alzheimer's disease or related disorders). Rule-making shall
18 be initiated by the Department by March 1, 2000. The
19 evaluation shall be performed by an independent agency who
20 (1) has expertise in assessing and treating persons with a
21 chronic mental illness in other than a hospital setting, and
22 (2) in the prior 2 years received no income derived directly
23 or indirectly from any Illinois nursing home or any Illinois
24 nursing home association and no more than 5% of his or her
25 income from the care or treatment of any Illinois nursing
26 home resident. If the agent is not an individual, the
27 requirements of this Section with respect to income shall
28 apply to all persons who perform the evaluation.
29 (Source: P.A. 88-380; 89-507, eff. 7-1-97.)
30 (210 ILCS 45/3-212) (from Ch. 111 1/2, par. 4153-212)
31 Sec. 3-212. Inspection.
32 (a) The Department, whenever it deems necessary in
33 accordance with subsection (b), shall inspect, survey and
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1 evaluate every facility to determine compliance with
2 applicable licensure requirements and standards. An
3 inspection should occur within 120 days prior to license
4 renewal. The Department may periodically visit a facility
5 for the purpose of consultation. An inspection, survey, or
6 evaluation, other than an inspection of financial records,
7 shall be conducted without prior notice to the facility. A
8 visit for the sole purpose of consultation may be announced.
9 The Department shall provide training to surveyors about the
10 appropriate assessment, care planning, and care of persons
11 with mental illness (other than Alzheimer's disease or
12 related disorders) to enable its surveyors to determine
13 whether a facility is complying with State and federal
14 requirements about the assessment, care planning, and care of
15 those persons.
16 (a-1) An employee of a State or unit of local government
17 agency charged with inspecting, surveying, and evaluating
18 facilities who directly or indirectly gives prior notice of
19 an inspection, survey, or evaluation, other than an
20 inspection of financial records, to a facility or to an
21 employee of a facility is guilty of a Class A misdemeanor.
22 (a-2) An employee of a State or unit of local government
23 agency charged with inspecting, surveying, or evaluating
24 facilities who willfully profits from violating the
25 confidentiality of the inspection, survey, or evaluation
26 process shall be guilty of a Class 4 felony and that conduct
27 shall be deemed unprofessional conduct that may subject a
28 person to loss of his or her professional license. An action
29 to prosecute a person for violating this subsection (a-2) may
30 be brought by either the Attorney General or the State's
31 Attorney in the county where the violation took place.
32 (b) In determining whether to make more than the
33 required number of unannounced inspections, surveys and
34 evaluations of a facility the Department shall consider one
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1 or more of the following: previous inspection reports; the
2 facility's history of compliance with standards, rules and
3 regulations promulgated under this Act and correction of
4 violations, penalties or other enforcement actions; the
5 number and severity of complaints received about the
6 facility; any allegations of resident abuse or neglect;
7 weather conditions; health emergencies; other reasonable
8 belief that deficiencies exist.
9 (b-1) The Department shall not be required to determine
10 whether a facility certified to participate in the Medicare
11 program under Title XVIII of the Social Security Act, or the
12 Medicaid program under Title XIX of the Social Security Act,
13 and which the Department determines by inspection under this
14 Section or under Section 3-702 of this Act to be in
15 compliance with the certification requirements of Title XVIII
16 or XIX, is in compliance with any requirement of this Act
17 that is less stringent than or duplicates a federal
18 certification requirement. In accordance with subsection (a)
19 of this Section or subsection (d) of Section 3-702, the
20 Department shall determine whether a certified facility is in
21 compliance with requirements of this Act that exceed federal
22 certification requirements. If a certified facility is found
23 to be out of compliance with federal certification
24 requirements, the results of an inspection conducted pursuant
25 to Title XVIII or XIX of the Social Security Act may be used
26 as the basis for enforcement remedies authorized and
27 commenced under this Act. Enforcement of this Act against a
28 certified facility shall be commenced pursuant to the
29 requirements of this Act, unless enforcement remedies sought
30 pursuant to Title XVIII or XIX of the Social Security Act
31 exceed those authorized by this Act. As used in this
32 subsection, "enforcement remedy" means a sanction for
33 violating a federal certification requirement or this Act.
34 (c) Upon completion of each inspection, survey and
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1 evaluation, the appropriate Department personnel who
2 conducted the inspection, survey or evaluation shall submit a
3 copy of their report to the licensee upon exiting the
4 facility, and shall submit the actual report to the
5 appropriate regional office of the Department. Such report
6 and any recommendations for action by the Department under
7 this Act shall be transmitted to the appropriate offices of
8 the associate director of the Department, together with
9 related comments or documentation provided by the licensee
10 which may refute findings in the report, which explain
11 extenuating circumstances that the facility could not
12 reasonably have prevented, or which indicate methods and
13 timetables for correction of deficiencies described in the
14 report. Without affecting the application of subsection (a)
15 of Section 3-303, any documentation or comments of the
16 licensee shall be provided within 10 days of receipt of the
17 copy of the report. Such report shall recommend to the
18 Director appropriate action under this Act with respect to
19 findings against a facility. The Director shall then
20 determine whether the report's findings constitute a
21 violation or violations of which the facility must be given
22 notice. Such determination shall be based upon the severity
23 of the finding, the danger posed to resident health and
24 safety, the comments and documentation provided by the
25 facility, the diligence and efforts to correct deficiencies,
26 correction of the reported deficiencies, the frequency and
27 duration of similar findings in previous reports and the
28 facility's general inspection history. Violations shall be
29 determined under this subsection no later than 60 days after
30 completion of each inspection, survey and evaluation.
31 (d) The Department shall maintain all inspection, survey
32 and evaluation reports for at least 5 years in a manner
33 accessible to and understandable by the public.
34 (Source: P.A. 88-278; 89-21, eff. 1-1-96; 89-171, eff.
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1 1-1-96; 89-197, eff. 7-21-95; 89-626, eff. 8-9-96.)
2 Section 20. The Mental Health and Developmental
3 Disabilities Code is amended by changing Section 1-114 as
4 follows:
5 (405 ILCS 5/1-114) (from Ch. 91 1/2, par. 1-114)
6 Sec. 1-114. "Mental health facility" means any licensed
7 private hospital, institution, or facility or section
8 thereof, and any facility, or section thereof, operated by
9 the State or a political subdivision thereof for the
10 treatment of persons with mental illness and includes all
11 hospitals, institutions, clinics, evaluation facilities, and
12 mental health centers which provide treatment for such
13 persons. "Mental health facility" includes any long term care
14 facility as defined in Section 1-113 of the Nursing Home Care
15 Act which meets the definition of "institution for mental
16 diseases" in 42 U.S.C. 1396d(i).
17 (Source: P.A. 88-380.)".